Stroke May Be Striking at a Younger Age

WEDNESDAY Sept. 2, 2009 -- Stroke could be affecting Americans earlier in life than ever before, a new study suggests.

"Stroke is no longer an affliction of old age," said lead researcher Timothy J. Wolf, an instructor of occupational therapy and neurology and investigator for the Cognitive Rehabilitation Research Group at Washington University School of Medicine, in St. Louis. "People in the working ages of life are having strokes with greater regularity than ever before."

Reporting in the September/October issue of the American Journal of Occupational Therapy, the team also found that while more people under the age of 65 are suffering strokes, rehabilitation is often not offered to younger people with mild stroke.

Wolf and his colleagues gathered data on 7,740 people treated for stroke at a St. Louis hospital between 1999 and 2008. They found that 45 percent were under 65 and 27 percent were under the age of 55. This differs drastically from data from the U.S. National Institutes of Health, which states that 66 percent of all strokes occur in people over 65, the researchers noted.

Most of the strokes among those under 65 were mild. "These individuals typically do not have outward signs of impairment and therefore are discharged with little or no rehabilitation," Wolf noted. "What we now know though, from following up with this group of people, is that they are having trouble reintegrating back into complex activities of everyday life such as employment," he said.

About 71 percent of patients who had a mild to moderate stroke were discharged directly home, discharged with home services only, or discharged with outpatient services only, the researchers found.

On follow-up, 46 percent of those with a mild stroke said they were working slower, 42 percent said they were not able to do their job as well, 31 percent said they were not able to stay organized and 52 percent said they had problems concentrating.

"If you are young and have a mild stroke, chances are you will not receive rehabilitation services," Wolf said. "That does not mean that you do not have any impairments. It means that we as a health-care community are not doing a good enough job at detecting the more subtle deficits associated with mild stroke."

The health-care community needs to pay more attention to this trend in strokes, and begin to modify assessment and intervention strategies to meet the needs of younger, less neurologically impaired stroke patients, Wolf said.

"Right now, our services are heavily weighted toward assessment and intervention for motor impairments and preparing an individual with a stroke to return home," he said. However, "the younger working age stroke survivor has needs that go way beyond self-care, and he or she needs to be able to return to work and community roles," Wolf stated.

Dr. Richard Isaacson, an assistant professor of neurology and medicine at the University of Miami Miller School of Medicine, said that while people may be having strokes younger, it is hard to know from this single study whether this is a trend throughout the United States.

Nevertheless, "this brings attention to the fact that stroke is not just a disease of old people, it's a disease of people as we age," Isaacson said.

He speculated that if a trend exists it could be due to risk factors for stroke, including high blood pressure, high cholesterol, diabetes and obesity. "People in their middle-age need to realize they need to control these risk factors," Isaacson added.

And he agreed that doctors need to do more to help younger people with mild strokes re-enter their lives.

"Neurologists do not obtain enough information to determine whether a patient will have difficulty with returning to work, family and other life events," Isaacson said. "A lot of times we don't realize that this person needs occupational therapy to help them focus in getting back to full participation in their previous activities."